Supplier Registration

Company Information * = Required Field
Legal Name: *
D/B/A Name:
Company Address Line 1: *
Company Address Line 2:
City: *
State:
ZIP:
Country:
Main Phone: *
Main Fax:
Website:
Supplier Type: *
Owner's Name:
Representative / Contact  
Name: *
Title: *
Telephone: *
Fax:
Email Address:
Product/Service Offering  
Primary Offering: *
Secondary Offering:
Tertiary Offering:
NAIC Code: * lookup
SIC Code: lookup
DUNS # (if available):
Years in Business: *
Number of Employees: *
Last Fiscal Year Sales: *
Number of Locations: *
Geographic Coverage: *
Service Locale(s):
Supplier Diversity Information  
Ethnic Group of Owner: *
Diversity Category*
 Certifying Agency
 Expiration Dates Self-Certification
Self Certify?
Self Certify?
Self Certify?
Self Certify?
Additional Information  
How were you referred to TEREX?
Are you a current Supplier:? *
Which TEREX company do you currently supply goods/services to?
Comments:?

Note that all 8(a) and HubZone companies MUST be certified by the SBA and must submit documentation. Companies may not self-certify their 8(a) or HubZone status.

NOTICE: There are Federal and State government penalties associated with misrepresenting your diversity or small business status. If you are unsure of status or eligibility, please contact the Small Business Administration (SBA) office in your area or any of the applicable certifying agencies. If there are any changes to your status subsequent to completing this form, it is your responsibility to notify Terex once these changes occur.

I hereby certify that I have read this certification and know the contents thereof, and that the business category indicated above reflects the true and correct status of the business in accordance with Federal Small Business Administration criteria and Federal Acquisition Regulations, FAR 19 pertaining to small, minority, women-owned, veteran-owned, disabled, service-disabled, veteran and hub-zone enterprises. I understand that falsely certifying the status of this business, obstructing, impeding or otherwise inhibiting Terex employee who is attempting to verify the information on this form may result in suspension from participation in Terex contracts.